Making Your Antimicrobial Stewardship Efforts Highly Reliable

If you work in the quality space in healthcare, chances are you’ve heard of high reliability organizations (HROs). For anyone unfamiliar with the term, HROs are organizations that have very low rates of failure, despite operating in extremely hazardous environments – like airlines or nuclear power plants.

They achieve this by following five key principles:

A preoccupation with failure.

A reluctance to simplify.

Sensitivity to operations.

A commitment to resilience.

Deference to expertise.

These principles can be applied in many ways to healthcare – if you’re interested in better understanding the high-level principles of HROs and their applications in healthcare, you can watch our on-demand webinaron the topic.

However, practices associated with HROs can be applied in specific contexts as well, including your organizations antimicrobial stewardship (AMS) efforts. Why do these principles fit in with AMS? Because the responsible use of antibiotics ultimately leads to safer healthcare – for everyone!

If at first you don’t succeed, huddle again

Safety huddles are a common practice in HROs and have great potential in healthcare. The huddles, which consist of a short, daily meeting for staff, are a crucial opportunity to reinforce key safety messages and objectives. Bassett Medical Centre successfully used safety huddles to boost stalled patient safety event reporting. Consider implementing AMS-focused huddles in your organization (or incorporate a few minutes on AMS into your existing meetings). Consistent reminders can help keep your organization focused on and accountable to its AMS goals.

Get hands-on

Colorado Children’s Hospital made AMS a front-line and top-of-mind priority every day through their “handshake stewardship” program. The program includes a daily review of every inpatient antibiotic prescription and daily rounding by a pharmacist-physician team to monitor antibiotic use and give in-person advice. This very hands-on approach keeps awareness and focus on AMS high and keeps front-line staff constantly vigilant about inappropriate or unnecessary use of antibiotics. Though it does require additional time and resources, an in-person, front-line approach encourages accountability in a way that memos and policies cannot.

Leverage your experts and defer to them in times of crisis

HROs are experts in being safe in their line of work. They recognize that front-line workers have a depth of knowledge in their area of expertise that no one else does and defer to those experts. Healthcare organizations have built-in experts that can inform your approach to AMS. According to the CDC’s guidelines for successful AMS programs, the best practice is to involve an interdisciplinary team that is led by pharmacy and physician leads and includes: clinicians and department heads, infection preventionists and epidemiologists, quality improvement staff, laboratory staff, information technology staff and nurses. This way, in times of crisis or when barriers to AMS arise, you’ll be well-positioned to defer to the team member with the most expertise.

At the end of the day, antimicrobial stewardship is about creating a safer, more reliable healthcare system for everyone. Taking a page out of the HRO strategy book can help you and your organization achieve AMS goals.